Cardiac + Digoxin Mindmap

Drugs for prophylactic management of CAD

Aspirin + statins

Prophylactic drugs to prevent angina

BBs (metoprolol)/CCBs; isosorbides

Drug used to treat acute angina and acute chest pain from ACS/MI by decreasing O2 demand (it increases perfusion)

NTG

ACS is a group of disorders. typically

STEMI (main one), NSTEMI, unstable angina

Drugs used to treat acute phase of ACS (STEMI)

MONA (NTG + aspirin first)

MONA → chest pain/ACS (give NTG + aspirin first)

Morphine, oxygen, NTG, aspirin

NTG’s role in treating acute phase of ACS (STEMI)

Decrease preload/afterload, improves O2 delivery to myocardium via vasodilation

Do not combine this drug with PDE inhibitors (Viagra/sildenafil; tadalafil; milrinone) as this creates profound hypotension

NTG/nitrates

Patient is suffering from acute exacerbation of HF and they are experiencing pulmonary edema with fluid overload. What should be given?

• Treat pulmonary edema → IV NTG + airway support (BiPap & mechanical ventilation)

• Treat fluid overload → Loop diuretics

Acute exacerbation of HF that leads to cardiogenic shock (low CO, low BP, high HR) should be treated with

Vasopressors; epi & norepi

Drugs that improve the squeeze in HF

Positive inotropes: digoxin & milrinone

Before administering digoxin, what should the nurse check?

• Serum potassium

• Check apical pulse for 1 full minute; hold if HR < 60

Neprilysin inhibitor

Sacubitril

Neprilysin inhibitor MOA

Inhibit break down of NPs

HF causes

ACS

Definitive treatment of STEMI (ACS)

1) If cath lab available → stent placement

2) If not cath lab → alteplase + streptokinase

Acute chest pain from ACS, MI is caused by

Decreased ability to meet O2 demand (lactic acidosis); this is caused by increased demand of the heart due to tachycardia and HTN; treat with BBs/CCBs

Drugs that prevent chest pain from CAD

Isosorbides (mono/di); CCBs & BBs

These drugs treat tachycardic rhythms

BBs and CCBs

Drug that cause pulmonary and hepatic toxicity, as well as thyroid problems

Amiodarone

Drugs that treat irregular Afib

Amiodarone, BBs, CCBs

Things that treat Vfib

Defibrillation

Chlorthalidone is used for

Stronger thiazide for African Americans; used for HTN, HF

Drug used to treat torsades de pointes (dysrhythmia)

IV magnesium sulfate

Drugs used to treat SVT (stable and unstable)

• Adenosine (6, 12, 12 mg) FAST; if don’t work, SVT is considered unstable

• Synchronized cardioversion (unstable SVT)

What should be anticipated if nurse is giving adenosine

• Patient feels impending feeling of doom

• Heart rate goes to zero (flatline; asystole) 

Drug used to treat bradycardic rhythms (symptomatic)

Atropine

If patient is asystole (0 pulse; flatlining), the nurse should

Perform CPR, give epi

Why is IV NTG good for treating pulmonary edema caused by HF?

NTG quickly drops left-sided pressures forcing fluid into lungs; decrease preload (venous) + afterload (arterial); decrease O2 demand, increase supply

Digoxin is not the first line for most HF cases/situations. True or false

True

Important patient teaching for digoxin

• Do not double dose

• Can take if < 6 hours within missed dose (e.g. if patient misses dose by 2 hrs, they can still take it)

• Take at the same time each day

Digoxin indication

• HF

• Improve the squeeze

• PINC

Therapeutic index of digoxin

0.5/0.8-2.0

Antidote for digoxin

digoxin immune fab (Digibind)

Symptoms of digoxin toxicity

• NVD

• Visual changes/disturbances

• Confusion/HA

• Ventricular dysrhythmias (Vfib)

If HR < 60

Hold digoxin/BBs/CCBs; notify provider 

A provider has orders for a MAP goal between 65-70 for a patient receiving Norepinephrine at 8 mcg/min with titration parameters every 5 minutes. Their current blood pressure at the 5 minute mark is 100/60. What is the patient's MAP and does it reach the goal?

Use the previous question/information to answer: If the provider has orders to titrate -/+2 until the patient's MAP reaches the goal, what would be the new dose?

MAP = 73; new dose = 6 mcg/min